Abstract
Purpose :
Few data exist to describe the effect of intravitreal injection (IVI) of anti-vascular endothelial growth factor (anti-VEGF) agents in neovascularisation following central retinal vein occlusion (CRVO). In a retrospective observational clinical study we aim to describe the rate and delay of neovascularisation in CRVO treatment naïve CRVO given anti-VEGF IVIs.
Methods :
The electronic medical record at Newcastle Eye Centre, U.K., was interrogated for all treatment naïve CRVOs without pre-existent neovascularisation, receiving anti-VEGF IVIs between January 2014 and December 2017. Of 219 CRVO eyes with a mean follow-up from IVI initiation of 26 months, 11 (5.0%) eyes (6 left, 1 pseudophakic) from 11 patients (7 male, 3 diabetic, mean age 74.8) developed neovascularisation (10 iris, 1 optic disc, 2 elsewhere). 6 eyes received aflibercept IVIs and 5 received ranibizumab. Due to the limited cohort size mainly descriptive statistics were performed.
Results :
Mean visual acuity at treatment initiation was 41.5 EDTRS letters (SD 24.0, range 0-83) in the whole cohort and 19.8 ETDRS letters (SD 19.6, range 0-52) in eyes with subsequent neovascularisation (p=0.004). Of all CRVO treatment naïve eyes with a starting vision less than 35 ETDRS letters, 70 (89.7%) were not observed to develop neovascularisation over a mean 24.2 months of follow-up. Mean time from treatment initiation to neovascularisation was 17.4 months later (SD 10.1) with a mean visual acuity of 12.0 letters (SD 16.8) at first neovascularisation. The mean time from most recent IVI to rubeosis development was 11.6 months (range 3-28); 11.1 and 12.1 months for eyes receiving ranibizumab and aflibercept respectively. Mean VA change was +13.2, +3.9 and -5.0 at 3, 6 and 12 months from IVI initiation respectively. Following IVI initiation for CRVO these 11 eyes received a mean of 3.2, 3.8 and 4.6 IVIs with 50%, 44% and 12% having no macular oedema at 3, 6 and 12 months respectively.
Conclusions :
These real world data confirm the relevance of clinical trial data demonstrating that anti-VEGF IVIs suspend rather than prevent neovascularisation in CRVO. In addition they do not demonstrate any substantial difference in the longevity of this neovascular suspension between ranibizumab and aflibercept. As rubeosis can occur up to 28 months from the conclusion of IVI therapy for CRVO long term vigilance is required.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.